Let’s talk about something important – mucosal melanoma. This is a rare type of melanoma not caused by sunlight or ultraviolet (UV) exposure. Only 1 to 2 out of 100 melanoma cases (1% to 2%) are mucosal melanoma[1]. It develops in the mucous membranes of the body, that are found in the lining of the mouth, nose, throat, anus, or genital areas. While not as common as other skin cancers, mucosal melanoma tends to grow and spread quickly, a process referred to as metastases, and is often diagnosed at a late stage.
Early detection is key to improving outcomes, making it vital to be able to recognize the signs of mucosal melanoma and raise awareness of this rare disease.
Where does Mucosal Melanoma Occur?
- The lining of the sinuses, nose (nasal passages), mouth, and throat. Approximately 50% of cases occur here.[2]
- The female genital tract and anal or rectal area. Approximately 24% of cases occur here.
- The urinary tract. Approximately 3% of cases occur here.
Signs and Symptoms of Mucosal Melanoma:
Some common signs and symptoms of mucosal melanoma include[3][4]:
- A lump or growth in the affected area.
- Lesions or masses inside the mouth, cheeks or lips.
- Bleeding or discharge from the affected area – there may be pain or bleeding from the anus or even vaginal pain, bleeding, discharge or itching.
- Pain or discomfort in the affected area.
- Abdominal pain on the right side of the abdomen.
- Hemorrhoids that don’t heal.
- If the affected area is the throat, there may be difficulty swallowing or speaking.
- If the affected area is the nose, there may be difficulty breathing, pain inside the nose, or nosebleeds.
- The skin or whites of the eyes may be yellowed.
If you experience any of these symptoms, you must see a physician right away. Despite these signs being common indicators of mucosal melanoma, it is essential to have any new, painful, or bleeding areas of the body checked by a physician. Like most cancers, the earlier it is detected, the easier it is to treat. This holds even more significance for mucosal melanoma due to its rapid growth and high likelihood of spreading to other parts of the body.
What can Mucosal Melanoma Be Mistaken For?
Mucosal melanoma can sometimes be mistaken for other conditions, causing delays in diagnosis. This is because a lot of the symptoms of mucosal melanoma are general and hard to differentiate from other conditions. Additionally, since mucosal melanoma is so rare, not many people, or even physicians, will suspect that melanoma is the cause of these symptoms:
- Polyps[5] – A polyp is a projecting growth of tissue, typically from a mucous membrane, and can develop in the rectum, nose, or throat. These are also common areas that mucosal melanoma develops, making it easy to confuse between the two. They can also cause bleeding, discharge, or pain, similar to mucosal melanoma.
- Hemorrhoids – Swollen veins in the anus and lower rectum that sometimes cause rectal bleeding. [6]Unlike hemorrhoids, mucosal melanoma will not heal.
- Ulcers – An open, crater-like sore on the top layer of skin or mucous membrane that is caused by inflammation, trauma, or infection. [7] The mucous membrane lines many parts of the body, including the mouth, nose, eyelids, throat, stomach, intestines, and the ureters, urethra, and urinary bladder. [8]An ulcer that will not heal may be a sign of mucosal melanoma.
- Genital Warts – Caused by the human papillomavirus, these flesh-colored, light and pearly, or dark purple, gray, or brown lesions are transmitted by skin-to-skin contact. Genital warts typically affect the penis, vulva, and anus areas, but can also develop in the mouth. Sometimes genital warts can go away on their own without treatment, however, mucosal melanoma will never go away on its own[9].
Risk Factors for Mucosal Melanoma
The risk factors for mucosal melanoma still remain unclear and many people who do develop mucosal melanoma don’t have any of the below risk factors. Mucosal melanoma can affect anymore. However, here are some risk factors for mucosal melanoma to be aware of[10][11]:
- Age – mucosal melanoma is more common in older adults and the average age at diagnosis is over 70.
- Exposure – to certain chemicals or carcinogens in the environment.
- Smoking – is a risk factor for mucosal melanoma within the head and neck.
- HIV – Human immunodeficienty virus is a possible risk factor for mucosal melanoma within the anus.
- Gender – women are more likely than men to develop mucosal melanoma
- Genetics – some people may have a genetic predisposition to mucosal melanoma.
- Race – Mucosal melanoma is more common in people with darker skin tones than lighter ones.
- Family history – people with a family history of melanoma may be at increased risk.
Treating Mucosal Melanoma
The treatment of mucosal melanoma is not always clear and treatment plans will depend heavily on the size, type, and location of the tumour. The best treatment of mucosal melanoma is the complete surgical removal (resection) of the tumour. This has the highest likelihood of a good prognosis, however, it best completed when the mucosal melanoma has not spread and is diagnosed early.
For advanced mucosal melanoma that has spread (metastasized) and cannot be removed by surgery (meaning it is unresectable) then it can be treated with radiation therapy. Compared to other forms of melanoma, mucosal melanoma does not respond well to immunotherapy. Currently, the best treatment options for patients with advanced mucosal melanoma are clinical trials focused on developing new therapies for mucosal melanoma such as different types of immunotherapies and drugs targeted to genomic mutations present in subsets of mucosal melanoma.
Detection
Did you know that 75% of melanomas are detected by patients themselves? Here are some steps you can take for the early detection of mucosal melanoma:
- Perform monthly self-exams: We encourage you to check your skin every month and report any new lumps, pigmented spots, ulcers or sores to your doctor. Refer to the signs and symptoms section of the article to identify areas of concern.
- Increase awareness: Talk to your friends and family about mucosal melanoma. Spreading awareness of this rare disease will increase the likelihood that someone may speak to their doctor about mucosal melanoma and receive an earlier diagnosis.
- Full-Body Skin Examinations by a Dermatologist: Schedule routine skin checks with a dermatologist, who can conduct a thorough examination and address any concerns. Find a dermatologist
Always remember, early detection is key. Perform regular skin self-exams, familiarize yourself with the signs and characteristics of mucosal melanoma and be on the lookout for any new growth or changes. If you notice something unusual or painful that fits the characteristics of mucosal melanoma, consult your family doctor promptly.
For an accurate assessment, it is crucial to consult with a healthcare professional for a thorough evaluation and proper diagnosis.
Facing a cancer diagnosis, especially a rare form, can be very distressing and isolating.
If you, or someone you love, has been diagnosed with mucosal melanoma, Melanoma Canada’s patient care specialist is available to support you. Please email support@melanomacanada.ca for more information.
If you have been diagnosed with mucosal melanoma, consider joining the Melanoma Research Alliance’s RARE Registry, a supportive and growing community of patients, advocates, and loved ones who are committed to advancing research of mucosal melanoma – https://www.raremelanoma.org/.
